Male Circumcision and Use of Foreskin Tissues for HIV Prevention in Uganda

项目摘要/摘要 医用男性包皮环切术(MMC)减少了男性感染艾滋病毒的机会，减少了男性和女性的病毒性性传播感染。 然而，许多非洲国家对MMC的接受程度低于预期，而且不成比例。 在更年轻、风险更低的男性中。迫切需要将实施科学纳入 定性/定量混合方法研究，以增加对MMC的需求，特别是在较高 风险人群；使用MC设备、任务转移/共享和移动MMC提高MMC服务的效率 并在人口一级监测复盖范围和影响。在基础科学层面上， MC期间收集的包皮为病毒学、免疫学研究提供了进入生殖器粘膜的独特途径 以及与艾滋病毒易感性或对艾滋病毒的保护有关的宿主遗传因素，对艾滋病毒有影响 预防。Rakai健康科学计划(RHSP)和Makerere大学公共卫生学院 乌干达的MakSPH与约翰·霍普金斯大学(JHU)合作了20多年。我们进行了 MMC的两次试验、试验后监督、MMC服务评估和MMC程序评估， 包括新的MMC设备。我们还在包皮的免疫学和病毒学研究方面进行了合作 组织和生殖器微生物群。该合作已通过以下方式培训了50多名学位和非学位学生 福格蒂国际中心(FIC)奖。我们建议继续这些培训工作，并提供 乌干达科学家专注于MMC相关研究的研究机会和职业发展， 这既是因为MMC对艾滋病毒预防至关重要，也是因为MMC相关研究为 广泛的协同和跨学科研究。具体地说，在JHU，我们建议培养一名博士 生殖器免疫学、病毒学和分子微生物学候选人，每小时5英里/MHS候选人 实施科学、流行病学和生物统计学、项目评估和混合方法研究。我们 将在MakSPH培训两名博士生，使用现有的允许短期培训的“三明治”博士学位 学员来京参加进修课程和辅导。在乌干达，我们将支持5名大师和3名 MakSPH和其他乌干达大学的学士学位实习生和18名文凭/证书实习生。 美国项目主任罗纳德·格雷博士，JHU和乌干达关键的流行病学教授 外国合作者是MakSPH教授David Serwadda博士。培训将通过培训进行监督 乌干达和美国的咨询委员会。RHSP/MakSPH将提供进入Rakai研究领域的途径 体验式培训网站，培训相关研究的数据和样本，以及丰富稳定的环境 职业发展。该计划建立在先前的培训和研究的基础上，以确保长期可持续性 以及作为世界级艾滋病毒研究机构的RHSP和MakSPH的领导地位。

Project Summary/ Abstract Medical male circumcision (MMC) reduces HIV acquisition in men, and viral STIs in men and women. However, uptake of MMC in many African countries is less than expected and has disproportionately been among younger, lower risk men. There is an urgent need for implementation science incorporating qualitative/quantitative mixed methods research to increase the demand for MMC, particularly among higher risk men; to increase the efficiency of MMC services using MC devices, task shifting/sharing and mobile MMC camps; and to conduct population-level monitoring of coverage and impact. At the basic science level, foreskins collected during MC provide unique access to genital mucosa for study of the virologic, immunologic and host genetic factors associated with vulnerability to or protection from HIV, with implications for HIV prevention. The Rakai Health Sciences Program (RHSP) and Makerere University School of Public Health (MakSPH) in Uganda have collaborated with Johns Hopkins University (JHU) for over 20 years. We conducted two trials of MMC, post-trial surveillance, evaluation of MMC services, and assessment of MMC procedures, including new MMC devices. We have also collaborated on immunologic and virologic studies of foreskin tissues and the genital microbiome. The collaboration has trained over 50 degree and non-degree students via Fogarty International Center (FIC) awards. We propose to continue these training efforts and to provide research opportunities and career development for Ugandan scientists focusing on MMC related research, both because MMC is vital to HIV prevention, and because MMC-related research provides an opportunity for a wide range of synergistic and interdisciplinary studies. Specifically, at JHU we propose to train one PhD candidate in genital immunology, virology and molecular microbiology, and 5 MPH/MHS candidates in implementation science, epidemiology and biostatistics, program evaluation and mixed methods research. We will train 2 doctoral students at MakSPH, using an established "sandwich" PhD which allows short-term trainees to come to JHU for advanced courses and mentoring. In Uganda, we will support 5 Masters and 3 Bachelors degree trainees, and 18 diploma/certificate trainees at MakSPH and other Ugandan universities. The U.S. Program Director (PD) Dr. Ronald Gray, Professor of Epidemiology at the JHU and the Ugandan Key Foreign Collaborator is Dr. David Serwadda, Professor, at MakSPH. Training will be overseen by Training Advisory Committees in Uganda and the US. RHSP/MakSPH will provide access to the Rakai research field site for experiential training, data and samples for training-related research, and a rich stable environment for career development. The program builds on prior training and research to ensure the long-term sustainability and leadership of RHSP and MakSPH as world class HIV research institutions.